n.

不消化。消化不良(dyspepsia)、胃弱。(不消化による)胃痛。[fig]消化不良

関: gastroesophageal reflux disease

WordNet

a disorder of digestive function characterized by discomfort or heartburn or nausea (同)dyspepsia, stomach upset, upset stomach
suffering from dyspepsia
a person suffering from indigestion

PrepTutorEJDIC

消化不良,不消化
消化不良,胃腸障害
消化不良の / 憂うつな / 消化不良の人,胃腸障害の人

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/09/07 00:52:25」(JST)

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[Wiki en表示]

Dyspepsia (from the Greek δυσ- dys- and πέψις pepsis "digestion"), also known as upset stomach or indigestion, refers to a condition of impaired digestion.^[1] It is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating.^[2] It can be accompanied by bloating, belching, nausea, or heartburn. Dyspepsia is a common problem, and is frequently associated with, gastroesophageal reflux disease (GERD) or gastritis. In a small minority it may be the first symptom of peptic ulcer disease (an ulcer of the stomach or duodenum) and occasionally cancer. Hence, unexplained newly onset dyspepsia in people over 55 or the presence of other alarming symptoms may require further investigations.^[3]

Functional dyspepsia (previously called nonulcer dyspepsia^[4]) is dyspepsia "without evidence of an organic disease that is likely to explain the symptoms".^[5] Functional dyspepsia is estimated to affect about 15% of the general population in western countries.^[4]

Signs and symptoms

The characteristic symptoms of dyspepsia are upper abdominal pain, bloating, fullness and tenderness on palpation.^{[citation needed]} Pain worsened by exertion and associated with nausea and perspiration may also indicate angina.^{[citation needed]}

Occasionally dyspeptic symptoms are caused by medication, such as calcium antagonists (used for angina or high blood pressure), nitrates (used for angina), theophylline (used for chronic lung disease), bisphosphonates, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs, used as painkillers).^[3]

The presence of gastrointestinal bleeding (vomit containing blood), difficulty swallowing, loss of appetite, unintentional weight loss, abdominal swelling and persistent vomiting are suggestive of peptic ulcer disease or malignancy, and would necessitate urgent investigations.^[3]

Diagnosis

People under 55 years, without alarm symptoms, can be treated without investigation. People over 55 years with recent onset dyspepsia or those with alarm symptoms should be urgently investigated by upper gastrointestinal endoscopy. This will rule out peptic ulcer disease, medication-related ulceration, malignancy and other rarer causes.^[3]

People under the age of 55 years with no alarm features do not need endoscopy but are considered for investigation for peptic ulcer disease caused by Helicobacter pylori infection. Investigation for H. pylori infection is usually performed when there is a moderate to high prevalence of this infection in the local community or the person with dyspepsia has other risk factors for H. pylori infection, related for example to ethnicity or immigration from a high-prevalence area. If infection is confirmed it can usually be eradicated by medication.

Medication-related dyspepsia is usually related to non-steroidal anti-inflammatory drugs (NSAIDs) and can be complicated by bleeding or ulceration with perforation of stomach wall.

Treatment

Functional and undifferentiated dyspepsia have similar treatments. Decisions around the use of drug therapy are difficult because trials included heartburn in the definition of dyspepsia. This led to the results favoring proton pump inhibitors (PPIs), which are effective for the treatment of heartburn. Traditional therapies used for this diagnosis include lifestyle modification, antacids, H2-receptor antagonists (H2-RAs), prokinetic agents, and antiflatulents. It has been noted that one of the most frustrating aspects of treating functional dyspepsia is that these traditional agents have been shown to have little or no efficacy.^[6]

Antacids and sucralfate were found to be no better than placebo in a literature review.^[7] H2-RAs have been shown to have marked benefit in poor quality trials (30% relative risk reduction^[7]), but only a marginal benefit in good quality trials.^[6] Prokinetic agents would empirically seem to work well since delayed gastric emptying is considered a major pathophysiological mechanism in functional dyspepsia.^[6] They have been shown in a meta-analysis to produce a relative risk reduction of up to 50%, but the studies evaluated to come to this conclusion used the drug cisapride which has since been removed from the market (now only available as an investigational agent)^[8] due to serious adverse events such as torsades, and publication bias has been cited as a potential partial explanation for such a high benefit.^[7] Modern prokinetic agents such as metoclopramide, erythromycin and tegaserod have little or no established efficacy and often result in substantial side effects.^[7] Simethicone has been found to be of some value, as one trial suggests potential benefit over placebo and another shows equivalence with cisapride.^[7] So, with the somewhat recent advent of the proton pump inhibitor (PPI) class of medications, the question of whether these new agents are superior to traditional therapy has arisen.

A 2002 systemic review of herbal products found that several herbs, including peppermint and caraway, have anti-dyspeptic effects for non-ulcer dyspepsia with "encouraging safety profiles".^[9] A 2004 meta-analysis, pooling data from three double-blind placebo-controlled studies, found the multiple herbal extract Iberogast to be significantly more effective than placebo (p value = .001) at treating patients with functional dyspepsia through the targeting of multiple dyspeptic pathologies.^[10] This German-made phytopharmaceutical was found to be equivalent to cisapride and significantly superior to metoclopramide at reducing the symptoms of functional dyspepsia over a four week period.^[11]^[12] Retrospective surveillance of 40,961 children (12 years and under) found no serious side-effects.^[13] Red pepper powder has also found to be promising.^[14] Ginger and related products made therefrom have been shown to have some positive alleviation of symptoms, in particular for motion sickness and pregnancy-related nausea ^[15]

Currently, PPIs are, depending on the specific drug, FDA indicated for erosive esophagitis, gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome, eradication of H. pylori, duodenal and gastric ulcers, and NSAID-induced ulcer healing and prevention, but not functional dyspepsia. There are, however, evidence-based guidelines and literature that evaluate the use of PPIs for this indication. A helpful chart summarizing the major trials is available from the functional dyspepsia guidelines published in the World Journal of Gastroenterology in 2006.^[6]

The CADET study was the first to compare a PPI (omeprazole 20 mg daily) to both an H2-RA (ranitidine 150 mg BID) as well as a prokinetic agent (cisapride 20 mg BID) alongside placebo.^[16] The study evaluated these agents in patients at 4 weeks and 6 months and noted that omeprazole had a significantly better response at 6 months (31%) than cisapride (13%) or placebo (14%) (p = .001) while it was just above the cutoff for being statistically significantly better than ranitidine (21%) (p = .053). Omeprazole also showed a significant increase in quality of life scores over the other agents and placebo in all but one category measured (p = .01 to .05).

The ENCORE study, which was a follow-up of patients from the OPERA study, showed responders to omeprazole therapy had fewer clinic visits than non-responders (1.5 vs 2.0) over a three month period (p < .001).^[17]^[18]

H. pylori connection

The relationship between H. pylori and functional dyspepsia has been controversial, with several trials finding a benefit and others finding no benefit; a 2003 Cochrane Collaboration review found that treating H. pylori did have a small effect in improving nonulcer dyspepsia symptoms.^[19]

More recently, "Helicobacter pylori eradication provided significant benefits to primary care patients with functional dyspepsia." according to a randomized controlled trial. ^[20] In this trial, the relative benefit ratio of Helicobacter pylori eradication for 50% reduction in symptoms at 12 months was 1.3 and, the relative benefit increase was 34.3%. In populations similar to those in this study which had a rate of benefit as measured by the 50% reduction in symptoms at 12 months of 36.5% without treatment, the number needed to treat is 8. ^[20]

References

Look up dyspepsia in Wiktionary, the free dictionary.

^ "dyspepsia" at Dorland's Medical Dictionary
^ Talley NJ, Vakil N (October 2005). "Guidelines for the management of dyspepsia". Am. J. Gastroenterol. 100 (10): 2324–37. doi:10.1111/j.1572-0241.2005.00225.x. PMID 16181387.
^ ^a ^b ^c ^d National Institute for Health and Clinical Excellence. Clinical guideline 17: Dyspepsia. London, 2004.
^ ^a ^b Saad RJ, Chey WD (August 2006). "Review article: current and emerging therapies for functional dyspepsia". Aliment. Pharmacol. Ther. 24 (3): 475–92. doi:10.1111/j.1365-2036.2006.03005.x. PMID 16886913. Free full-text
^ van Kerkhoven LA, van Rossum LG, van Oijen MG, Tan AC, Laheij RJ, Jansen JB (September 2006). "Upper gastrointestinal endoscopy does not reassure patients with functional dyspepsia". Endoscopy 38 (9): 879–85. doi:10.1055/s-2006-944661. PMID 16981103. Free full-text.
^ ^a ^b ^c ^d Mönkemüller K, Malfertheiner P (2006). "Drug treatment of functional dyspepsia". World J. Gastroenterol. 12 (17): 2694–700. PMID 16718755. http://www.wjgnet.com/1007-9327/12/2694.asp.
^ ^a ^b ^c ^d ^e Talley NJ, Vakil N (2005). "Guidelines for the management of dyspepsia". Am. J. Gastroenterol. 100 (10): 2324–37. doi:10.1111/j.1572-0241.2005.00225.x. PMID 16181387.
^ Information regarding withdrawal of Propulsid (cisapride) by Janssen Pharmaceutica. From FDA
^ Thompson Coon J, Ernst E (October 2002). "Systematic review: herbal medicinal products for non-ulcer dyspepsia". Aliment. Pharmacol. Ther. 16 (10): 1689–99. doi:10.1046/j.1365-2036.2002.01339.x. PMID 12269960.
^ Melzer J, Rösch W, Reichling J, Brignoli R, Saller R (2004). "Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast)". Aliment. Pharmacol. Ther. 20 (11–12): 1279–87. doi:10.1111/j.1365-2036.2004.02275.x. PMID 15606389.
^ Rösch W, Vinson B, Sassin I (2002). "A randomised clinical trial comparing the efficacy of a herbal preparation STW 5 with the prokinetic drug cisapride in patients with dysmotility type of functional dyspepsia". Z Gastroenterol 40 (6): 401–8. doi:10.1055/s-2002-32130. PMID 12055663.
^ Hanisch J, Bock P, Vinson B (2005). "The efficacy and safety of STW 5 versus Metochlopramide oral for functional dyspepsia under practice conditions (in German)". Med Klinik 100.
^ Liechtle K (1999). "Experience reports on the use of Iberogast in children (in German)". Forschungsbericht Steigerwald Arzneimittelwerk GmbH.
^ Bortolotti M, Coccia G, Grossi G, Miglioli M (June 2002). "The treatment of functional dyspepsia with red pepper". Aliment. Pharmacol. Ther. 16 (6): 1075–82. doi:10.1046/j.1365-2036.2002.01280.x. PMID 12030948.
^ UMM Medical Reference Section. "University of Maryland Medical Center". http://www.umm.edu/altmed/articles/ginger-000246.htm. Retrieved 2011-05-24.
^ Veldhuyzen van Zanten SJ, Chiba N, Armstrong D, et al. (2005). "A randomized trial comparing omeprazole, ranitidine, cisapride, or placebo in helicobacter pylori negative, primary care patients with dyspepsia: the CADET-HN Study". Am. J. Gastroenterol. 100 (7): 1477–88. doi:10.1111/j.1572-0241.2005.40280.x. PMID 15984968.
^ Talley NJ, Meineche-Schmidt V, Paré P, et al. (1998). "Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies)". Aliment. Pharmacol. Ther. 12 (11): 1055–65. doi:10.1046/j.1365-2036.1998.00410.x. PMID 9845395. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0269-2813&date=1998&volume=12&issue=11&spage=1055.
^ Meineche-Schmidt V, Talley NJ, Pap A, et al. (1999). "Impact of functional dyspepsia on quality of life and health care consumption after cessation of antisecretory treatment. A multicentre 3-month follow-up study". Scand. J. Gastroenterol. 34 (6): 566–74. doi:10.1080/003655299750026010. PMID 10440605.
^ Moayyedi P, Deeks J, Talley NJ, Delaney B, Forman D (December 2003). "An update of the Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsia: resolving the discrepancy between systematic reviews". Am. J. Gastroenterol. 98 (12): 2621–6. doi:10.1111/j.1572-0241.2003.08724.x. PMID 14687807.
^ ^a ^b Mazzoleni LE, Sander GB, Francesconi CF, Mazzoleni F, Uchoa DM, De Bona LR et al. (2011). "Helicobacter pylori eradication in functional dyspepsia: HEROES trial.". Arch Intern Med 171 (21): 1929–36. doi:10.1001/archinternmed.2011.533. PMID 22123802.

UpToDate Contents

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1. 消化性潰瘍：臨床症状および診断 peptic ulcer disease clinical manifestations and diagnosis
2. 救急外来における成人の腹痛の評価 evaluation of the adult with abdominal pain in the emergency department
3. 悪心および嘔吐を呈する幼児または小児に対するアプローチ approach to the infant or child with nausea and vomiting
4. 成人における胆嚢機能障害 functional gallbladder disorder in adults
5. 消化性潰瘍の合併症の概要 overview of the complications of peptic ulcer disease

English Journal

Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate-antacid (Gaviscon Double Action) - a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease.

Thomas E1, Wade A, Crawford G, Jenner B, Levinson N, Wilkinson J.Author information 1Category Development Organisation, Reckitt Benckiser, Slough, UK.AbstractBACKGROUND: The alginate-antacid, Gaviscon Double Action (Gaviscon DA; Reckitt Benckiser, Slough, UK) suppresses reflux after meals by creating a gel-like barrier that caps and displaces the acid pocket distal to the oesophago-gastric junction. The effect of Gaviscon DA on reflux and dyspepsia symptoms has not yet been demonstrated with a modern trial design.
Alimentary pharmacology & therapeutics.Aliment Pharmacol Ther.2014 Mar;39(6):595-602. doi: 10.1111/apt.12640. Epub 2014 Jan 28.
BACKGROUND: The alginate-antacid, Gaviscon Double Action (Gaviscon DA; Reckitt Benckiser, Slough, UK) suppresses reflux after meals by creating a gel-like barrier that caps and displaces the acid pocket distal to the oesophago-gastric junction. The effect of Gaviscon DA on reflux and dyspepsia sympt
PMID 24471505

A9.14 An observational study of the prevalence and clinical impact of NSAIDS on anemia and hemoglobin drop on clinical settings.

Faustino A.Author information Rheumatologic Clinic of Lisbon (RCL).AbstractBACKGROUND AND OBJECTIVES: Define the prevalence and clinical impact of the finding of anemia and decreased hemoglobin in a population of patients with osteoarthritis (OA) from the RCL, treated with NSAIDs permanently. Additionally, evaluate differences of the effect of anti-inflammatory medication in Hb and haematocrit (Htc), comparing Coxibs with nsNSAIDs.
Annals of the rheumatic diseases.Ann Rheum Dis.2014 Mar 1;73 Suppl 1:A97-8. doi: 10.1136/annrheumdis-2013-205124.226.
BACKGROUND AND OBJECTIVES: Define the prevalence and clinical impact of the finding of anemia and decreased hemoglobin in a population of patients with osteoarthritis (OA) from the RCL, treated with NSAIDs permanently. Additionally, evaluate differences of the effect of anti-inflammatory medication
PMID 24489360

New Approaches to Management of PPI-Refractory Gastroesophageal Reflux Disease.

Ates F1, Vaezi MF.Author information 1Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, C2104-MCN, Nashville, Tennessee, USA.AbstractOPINION STATEMENT: "Refractory GERD" is one the most common misnomers in the area of gastroesophageal reflux disease. The term implies reflux as the underlying etiology despite unresponsiveness to aggressive, often twice-daily proton pump inhibitor therapy. The term should be replaced with "refractory symptoms." We must acknowledge that in many patients, symptoms of reflux often overlap with non-GERD causes such as gastroparesis, dyspepsia, hypersensitive esophagus, and functional disorders. Lack of response to aggressive acid suppressive therapy often leads to esophagogastroduodenoscopy followed by pH or impedance monitoring. In the majority of patients these tests are normal. The role of non-acid reflux measured by impedance pH testing in this group is uncertain at best and the results from this test alone should not be used to refer patients to surgical fundoplication. In patients unresponsive to acid suppressive therapy, reflux is most commonly not causal and a search for non-GERD causes must ensue.
Current treatment options in gastroenterology.Curr Treat Options Gastroenterol.2014 Mar;12(1):18-33. doi: 10.1007/s11938-013-0002-7.
OPINION STATEMENT: "Refractory GERD" is one the most common misnomers in the area of gastroesophageal reflux disease. The term implies reflux as the underlying etiology despite unresponsiveness to aggressive, often twice-daily proton pump inhibitor therapy. The term should be replaced with "refracto
PMID 24430334

Coeliac disease screening in first-degree relatives on the basis of biopsy and genetic risk.

Vaquero L1, Caminero A, Nuñez A, Hernando M, Iglesias C, Casqueiro J, Vivas S.Author information 1aGastroenterology Unit bPathology Department cPaediatric Department, University Hospital of León, Altos de Nava s/n dInstitute of Molecular Biology (INBIOMIC) eMicrobiology Department fInstitute of Biomedicine (IBIOMED), University of León, León, Spain.AbstractBACKGROUND: Serological markers of coeliac disease (CD) lack diagnostic value to identify mild histopathological lesions mainly in adults at risk of CD.
European journal of gastroenterology & hepatology.Eur J Gastroenterol Hepatol.2014 Mar;26(3):263-7. doi: 10.1097/MEG.0000000000000020.
BACKGROUND: Serological markers of coeliac disease (CD) lack diagnostic value to identify mild histopathological lesions mainly in adults at risk of CD.AIMS: The aim of this study was to evaluate the usefulness of human leukocyte antigen (HLA)-DQ2/8 genotyping, followed by duodenal biopsy for the de
PMID 24300305

Japanese Journal

分子イメージング技術と創薬 : 製薬企業の立場からの一考察(誌上シンポジウム)

矢嶋一賀,西村伸太郎
藥學雜誌 129(3), 297-304, 2009-03-01
… However they may be still in learning phase, we must meet with complexity, high cost, and indigestion. …
NAID 110007123174

1)自律神経失調症状を示す内科疾患(<シンポジウム>各科における自律神経失調症状を呈する疾患について)

真島一郎,村松芳幸,本間信治
新潟医学会雑誌 116(9), 414-417, 2002-09-10
We studied the relationship between psychological factors and electrogastrographic change in patients with unidentified indrgestion symptoms. The results revealed that the psychological stress (mirror …
NAID 110004462598

胃全摘術後による消化不良が原因であると考えられた回腸魚骨穿孔の1例

平原典幸,渡部広明
日本農村医学会雑誌 51(1), 47-51, 2002-05-25
NAID 10010152250

Related Pictures

★リンクテーブル★

リンク元	「100Cases 16」「functional gastrointestinal disorder」「dyspeptic」「maldigestion」「消化障害」

「100Cases 16」

Dyspepsia
	Classification and external resources
ICD-10	K30
ICD-9	536.8
DiseasesDB	30831
MedlinePlus	003260
MeSH	C23.888.821.236

　　[★]

☆case16　膝の痛み

■glossary

indigestion 消化障害、消化不良

■症例

80歳　男性

主訴：左膝の痛みと腫脹

現病歴：左膝の痛みを2日前から認めた。膝は発熱・腫脹しており、動かすと疼痛を生じる。時々胸焼けと消化不良が見られる。6ヶ月前のhealth checkで、高血圧(172/102mmHg)と血中クレアチニンが高い(正常高値)こと以外は正常といわれた。その4週間数回血圧を測定したが、高値が継続したため、2.5mg bendrofluamethizide(UK)/ベンドロフルメチアジド bendroflumethiazide(US)で治療を開始した。最近の血圧は138/84 mmHgであった。

喫煙歴：なし。

飲酒歴：一週間に平均4unit。

既往歴：股関節に中程度(mild)の変形性関節症

家族歴：特記なし

服薬歴：アセトアミノフェン(股関節の疼痛に対して)

身体所見 examination

　血圧 142/86mmHg。体温37.5℃。脈拍88/分。grade 2 hypertensive retinopathy(高血圧症性網膜症)。心血管系、呼吸器系に検査場異常なし。手にDIPにヘバーデン結節なし。

　左膝が発熱し腫脹している。関節内に液、patellar tap陽性。90℃以上膝関節を屈曲させると痛みを生じる。右の膝関節は正常に見える。

検査　 investigation

　生化学：白血球増多、ESR 上昇、尿素高値、グルコース高値

　単純X線：関節間隙やや狭小。それ以外に異常は認めない。

■problem list

　#1 左膝の痛み

　#2 胸焼け

　#3 消化不良

　#4 高血圧

　#5 クレアチニン正常高値

　#6 股関節の変形性リウマチ

　#7 高血圧性網膜症

■考え方

　・関節痛の鑑別診断を考える。

　・VINDICATEで考えてみてもよいでしょう。

　・関節痛の頻度としては　外傷＞慢性疾患(OAなど)＞膠原病＞脊椎疾患＞悪性腫瘍

■関節痛の鑑別疾患

DIF 282

V Vascular 血友病 hemophilia, 壊血病 scurvy, 無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

I Inflammatory 淋疾 gonorrhea, ライム病 lyme disease, 黄色ブドウ球菌 Staphylococcus, 連鎖球菌 Streptococcus, 結核 tuberculosis, 梅毒 syphilis, 風疹 rubella, 単純ヘルペス herpes simplex, HIV human immunodeficiency virus, サイトメガロウイルス cytomegalovirus

N Neoplastic disorders 骨原性肉腫 osteogenic sarcoma, 巨細胞腫 giant cell tumors

D Degenerative disorders degenerative joint disease or 変形性関節症 osteoarthritis

I Intoxication 痛風 gout (uric acid), 偽痛風 pseudogout (calcium pyrophosphate), ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide, gout syndrome of diuretics

C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.